Lab and Imaging Studies

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Lab and Imaging Studies


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Lab Studies:

* No laboratory work is usually necessary.
* Results of cerebrospinal fluid (CSF) evaluation are abnormal in 61%.
o Pleocytosis is observed in 46%, elevated protein in 26%, and VZV DNA in 22%.
* These findings are not predictive of the PHN clinical course.
* Viral culture or immunofluorescence staining may be used to differentiate herpes simplex from herpes zoster in cases that are difficult to distinguish clinically.
* Antibodies to herpes zoster can be measured. A 4-fold increase has been used to support the diagnosis of subclinical herpes zoster (zoster sine herpete). However, a rising titer secondary to viral exposure rather than reactivation cannot be ruled out.

Imaging Studies:

* Magnetic resonance imaging (MRI) lesions attributable to HZ were seen in the brain stem and cervical cord in 56% (9/16) of patients.
* At 3 months after onset of HZ, 56% (5/9) of patients with an abnormal MRI had developed PHN.
* Of the 7 patients who had no HZ-related lesions on MRI, none had residual pain.

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